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PubMed1988

Immunological aspects of acute ureteral obstruction: immune cell infiltrate in the kidney.

Kidneys from rats subjected to bilateral ureteral obstruction (BUO), unilateral ureteral obstruction (UUO) and UUO with subsequent release were analyzed for leukocyte infiltration. A time-dependent influx of leukocytes, predominantly macrophages and suppressor T lymphocytes, occurred in both the cortex and medulla following obstruction, and disappeared with release of the obstruction. Glomerular macrophages declined following obstruction but increased to levels above control following release. The influx of leukocytes following obstruction was paralleled by an increase in thromboxane B2 excretion by the kidney and coincided with a decrease in glomerular filtration rate (GFR). This would suggest that an influx of immune cells is a prominent feature of the acute renal response to ureteral obstruction. These cells may modulate some of the post-obstructive alterations in renal function via the production of vasoactive substances, such as thromboxane A2.

Acute Disease↗
PubMed1999

Ureteral obstruction reverses glomerular proliferation in immune complex glomerulonephritis.

We investigated an effect of ureteral obstruction on a progressive immune complex glomerulonephritis in murine lupus erythematosus. Unilateral ureteral obstruction for 8 days significantly decreased the expanded glomerular mesangial area, as measured by computer-assisted morphometry (4.44 +/- 0.33 x 10(-4) mm2 to 3.60 +/- 0.34 x 10(-4) mm2, P < .05), and reduced the staining for IgG, C3, and extracellular matrix components, whereas the nephritis was exacerbated in the contralateral non-obstructed kidney. The renal concentration of prostaglandin E2 (PGE2) and 6-keto-prostaglandin F1alpha (6-keto-PGF1alpha) in the obstructed kidneys 8 days after obstruction significantly exceeded that of kidneys in sham-operated controls (344.2 +/- 83.9 pg/mg tissue protein vs 50.0 +/- 27.5 pg/mg tissue protein, P < .01; 71.9 +/- 11.4 pg/mg tissue protein vs 9.5 +/- 2.3 pg/mg tissue protein, P < .01), whereas thromboxane B2 (TxB2) levels were similar in the two groups (33.9 +/- 4.5 pg/mg tissue protein vs 31.3 +/- 2.6 pg/mg tissue protein). Next, an experiment was performed to evaluate the role of renal eicosanoids in the amelioration in the immune complex glomerulonephritis after ureteral obstruction. Treatment with the cyclooxygenase inhibitor indomethacin abolished the decrease in mesangial area induced by ureteral obstruction (7.7% +/- 6.9%). CV-4151, a thromboxane synthetase inhibitor, had no effect on the decrease in mesangial area (-25.8% +/- 6.8%, P < .05). We conclude that unilateral ureteral obstruction quickly decreased the mesangial expansion in immune complex glomerulonephritis, and vasodilatory eicosanoids such as PGE2 and PGI2 at least partly contribute to the amelioration of glomerular histology.

6-Ketoprostaglandin F1 alpha↗
PubMedDate not supplied

[Acute renal insufficiency secondary to ureteral obstruction].

Acute renal insufficiency due to ureteral obstruction is relatively uncommon and gives rise to difficulties of diagnosis and treatment. The series presented here analyzes these aspects in 24 patients who had 27 episodes of proven anuria due to ureteral obstruction. Their average age was 62. Six patients had only one kidney (25%). The most common etiology was cancer (two thirds of the cases), mainly of genitourinary origin (10/16). Calcium or uric acid urethral lithiasis was the main cause of obstruction in the benign group. Treatment corresponded to a wide range of obstruction removal procedures depending on the etiology, but in the secondary to cancer it was very aggressive and the most used was nephrostomy. The decision to perform any treatment of obstructive anuria in patients with cancer should take into account a variety of important aspects amongst which prevail the prognosis of the basal illness, the handling of cancerous pain, the complications and mortality associated with the procedure and the patient's prospects.

Acute Kidney Injury↗
PubMed1983

Impact of age on effects of ureteral obstruction on renal function.

Chronic partial ureteral obstruction of the urinary tract is a common congenital abnormality. Yet, its impact on the function of the kidney in the young has not been examined. To determine the relationship between age at the time of injury and outcome, partial ureteral obstruction was produced in guinea pigs during the first, second, third, fourth, or fifth week of life, and several variables of glomerular, proximal and distal tubular functions were measured 4 weeks later. The results were compared with those obtained in the contralateral kidney and with those observed in age-matched sham-operated animals. There was a significant impairment in the growth of the obstructed kidney. The weight of the contralateral kidney in the experimental animals was significantly greater than that of the obstructed (P less than 0.001) or control (P less than 0.005) kidney, but compensatory hypertrophy decreased progressively with age, being 30% of control when the obstruction was produced in the second week of life and only 2% when the obstruction occurred at 5 weeks of age. Obstruction resulted in a marked reduction in GFR at all ages, the impairment being inversely proportional with age. Conversely, the increase in GFR on the contralateral side, which was proportional with the increase in renal mass, diminished from 60.1 to 20.5% (r = 0.96, P less than 0.001) as a function age. Tubular reabsorption of phosphate was significantly lower in obstructed kidneys, particularly so in the animals sustaining obstruction during the first 2 weeks of life.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗
PubMed2001

Increased expression of atrial natriuretic peptide in ureteral obstructed kidneys in rats.

OBJECTIVES: Whether the natriuresis in the previously ureteral obstructed kidney may be related to an altered regulation of local atrial natriuretic peptide (ANP) was investigated. MATERIALS AND METHODS: Male Sprague-Dawley rats were unilaterally obstructed of the left ureters for 48 hours. The left and right ureters were separately cannulated to collect urine samples. In some rats, both kidneys were removed without releasing the obstruction. Control rats were treated the same except that no ureteral obstruction was made. The mRNA expression of ANP and natriuretic peptide receptor (NPR)-A was determined in the kidney by reverse transcription-polymerase chain reaction. The guanylyl cyclase activity was measured by the amount of cGMP generated in response to ANP. Plasma levels of ANP were measured by radioimmunoassay. RESULTS: The ureteral obstruction did not significantly affect the plasma ANP levels. In the obstructed kidney, the creatinine clearance was decreased, while the fractional excretion of sodium increased. The expression of ANP mRNA was increased in the obstructed kidney. The NPR-A mRNA expression was not altered in the glomerulus, but was decreased in the papilla of the obstructed kidney. Nor was the guanylyl cyclase activity in the glomerulus altered. Although the guanylyl cyclase activity in the papilla was significantly decreased in the obstructed kidney, it was rapidly resumed upon releasing the obstruction. CONCLUSIONS: An increased local expression of ANP may, at least in part, account for the natriuresis in the previously ureteral obstructed kidney.

Animals↗
PubMed1997

Partial ureteral obstruction: effect of intravenous normal saline and furosemide upon the renal resistive index.

OBJECTIVE: To investigate the effect of intravenous normal saline fluid load, with and without furosemide, upon the renal resistive index (RI) of obstructed and nonobstructed kidneys. METHODS: Right partial ureteral obstruction was induced in 10 dogs. Grade 1 (mild) obstruction was performed in 5 dogs (group A), and grade 3 (severe) obstruction was carried out to the remaining 5 dogs (group B). Evaluation by Doppler ultrasonography was performed before induction of ureteral obstruction and by the end of the 8th week of obstruction. Every obstructed animal was subjected to bilateral renal Doppler ultrasonography 3 times in one setting: 1) before infusion of normal saline, 2) 30-60 minutes after intravenous infusion of normal saline (15 ml./kg.) given in a rate of 1 ml./kg./min. and 3) 10 minutes after admission of furosemide (1 mg./kg.). RESULTS: After induction of right partial ureteral obstruction, there was a significant increase of the RI of the right kidney and a significant decrease of the RI of the left kidney compared to baseline RI in both groups. Infusion of normal saline and administration of furosemide caused a further significant increase of the RI of the obstructed kidney and a further significant decrease of the RI in the nonobstructed kidney in both groups. CONCLUSION: In unilateral partial ureteral obstruction, addition of intravenous normal saline and furosemide cause the RI to increase in obstructed kidney and to decrease in nonobstructed kidney. Such a divergent response may be useful for the development of a pharmacologically challenged Doppler examination to diagnose better potentially obstructed kidneys.

Animals↗
PubMed1997

Perirenal MR high signal--a new and sensitive indicator of acute ureteric obstruction.

PURPOSE: This study was carried out to determine the incidence of perirenal magnetic resonance (MR) high signal in acute ureteric obstruction as demonstrated by half-Fourier acquisition single shot turbo spin-echo (HASTE) MR. In addition, we evaluated the sensitivity of this perirenal MR high signal as a predictor of acute ureteric obstruction. MATERIALS AND METHODS: A prospective evaluation of 55 consecutive patients with suspected ureteric obstruction was carried out using the HASTE MR sequence. Images were compared to concurrent IV urography (IVU) or to computed tomography (CT) where these were available. Acute and chronic ureteric obstruction were differentiated by clinical evaluation. RESULTS: Forty-one patients had obstructed kidneys. HASTE MR accurately predicted the presence of acute ureteric obstruction in 20/23 (87%) based on presence of perirenal MR high signal. None of these showed evidence of contrast medium extravasation on the concurrent i.v. urogram. 15/18 (83%) chronically obstructed kidneys demonstrated no perirenal high signal on HASTE MR, and the remaining three showed only a trace of perirenal high signal. CT showed perirenal stranding in only 2/8 patients with acutely obstructed kidneys. CONCLUSION: In acute ureteric obstruction, HASTE MR shows perirenal high signal intensity much more commonly than IVU shows extravasation or CT showing perirenal stranding. The origin of this MR signal is uncertain but may represent oedema, lymphatic distension or free fluid from forniceal rupture. HASTE MR can accurately distinguish between acute and chronic ureteric obstruction based on the degree of perirenal high signal.

Acute Disease↗
PubMed1990

Leuprolide acetate in the management of ureteral obstruction caused by endometriosis.

Endometriotic ureteral obstruction is a serious event commonly diagnosed late and therefore associated with a major risk of hydronephrotic renal atrophy. The standard therapy is surgical. However, medical treatment has been reported using danazol, progestins, and estrogen-progestin combinations, although solid documentation of the effect of hormonal therapy against ureteral endometriosis is lacking. Gonadotropin-releasing hormone (GnRH) agonist treatment of endometriosis has yielded good results but has not been adequately reported in patients with ureteric involvement. We report three patients treated with a GnRH agonist, leuprolide acetate, for 6-9 months as a preoperative course. One patient had bilateral and two had unilateral obstruction. The preoperative course relieved the obstruction in the patient with bilateral disease and in one with unilateral changes. The failure occurred in a patient with intrinsic ureteric endometriosis. This early experience suggests a place for GnRH agonist therapy for patients with ureteric obstruction due to endometriosis, probably, but not necessarily, in conjunction with a planned surgical procedure. If medical therapy is attempted, close surveillance of renal function is mandatory.

Adult↗
PubMed1982

Decreased renal prostaglandin metabolism in ureteral obstruction.

Studies were performed in rabbits to assess whether alterations in renal prostaglandin metabolism occur with ureteral obstruction. After 3 days, the cortical metabolism of prostaglandin E2 (as measured by prostaglandin E2-9-ketoreductase activity) decreased by almost 40% in unilateral and 50% in bilateral ureteral obstruction when compared to appropriate control levels. Medullary prostaglandin E2 metabolism decreased by 70% after unilateral ureteral obstruction but was unchanged in response to bilateral ureteral obstruction. Enzyme kinetics data from bilateral ureteral obstructed and sham-operated kidneys revealed non-competitive inhibition. In contrast to metabolism, cortical prostaglandin E2 biosynthesis increased by 122% over the control levels in unilateral, and 205% in bilateral ureteral obstruction. However, medullary prostaglandin E2 synthesis fell by almost 40% after bilateral obstruction. These data suggest that decreased renal prostaglandin metabolism, together with increased biosynthesis, could have significant effects on local prostaglandin tissue concentrations and thus explain the enhanced activity of these lipids previously noted in this model.

Animals↗
PubMed1989

Ureteric obstruction by the gravid uterus.

This paper reports the only 6 cases of ureteric obstruction apparently caused by the gravid uterus diagnosed at the Mercy Maternity Hospital in the past 17 years, during which time there were 82,836 confinements. In 3 of the 6 cases there was clear radiographic evidence that the level of obstruction was at the pelvic brim. The rapid resolution of the ureteric obstruction shortly after delivery strongly suggested that the gravid uterus was the cause of the obstruction. Cases 1-3 were the only patients of 793 with polyhydramnios who developed bilateral ureteric obstruction and acute renal failure. In Cases 4 and 5 there was unilateral ureteric obstruction and pyelonephritis; in Case 4 a ureteric catheter was inserted from below, and in Case 5 a ureteric stent was inserted via a nephrostomy tube. In Case 6 a percutaneous nephrostomy tube was inserted.

Adolescent↗
PubMed1989

[Extracorporeal shock wave lithotripsy in renal calculi causing ureteral obstruction: report of 20 cases].

From Dec. 1985 to July 1988, 2006 patients with renal calculi were treated with Zhongshan Hospital JT-ESWL-I and France EDAP machines. Post-treatment obstruction of ureteral street stones occurred in 20 patients (1% in this series) with large renal calculi: 10 cases occurred in the left ureter, whereas the others in the right. The length of street stones measured 3-22 cm. Among the 20 cases, 14 patients were cured by medicine, repeated ESWL, or/and endoscopical manipulation. Two patients with acute renal failure were completely free of ureteral stones after nephrostomy or placement of a ureteral catheter and irrigation. 2 patients are still under treatment. In addition, some factors of the formation, prevention and treatment of the ureteral street stones are discussed in this paper.

Adult↗
PubMed1987

Posttreatment ureteral obstruction in invasive carcinoma of uterine cervix.

There were 2,016 new cases of invasive carcinoma of the cervix (Stages I-IV) who were seen from January 1951 to January 1981, in LSU Medical Center. One thousand, one hundred and five cases were Stages I and II (early stages), and 911 cases were Stages III and IV (advanced stages). One hundred and thirty-seven cases of early stages (12%) were recorded to have ureteral obstruction that developed after completion of the treatment for cervical carcinoma. Ninety-four (69%) of the 137 patients with ureteral obstruction in early stages are dead, and autopsy information is available in 28 cases. There was evidence of cervical carcinoma causing ureteral obstruction in 13 autopsy cases. Of the 66 patients who died and were not autopsied, 26 cases had biopsy-proven evidence of either persistent or recurrent cervical carcinoma. All 43 patients surviving in this group are biopsy negative or clinically with no evidence of disease (NED). One hundred and sixty-three patients in advanced stages (18%) who did not have ureteral obstruction prior to definitive treatment for cervical carcinoma developed ureteral obstruction after completion of treatment. One hundred and forty-two (87%) of the 163 patients with ureteral obstruction in advanced stages are dead, and autopsy information is available in 36 cases. There was evidence of recurrent or persistent carcinoma causing ureteral obstruction in 25 cases (69%). Of the 106 patients who died and were not autopsied, 76 had biopsy-proven Ca (72%) in the pelvis and abdomen prior to death. In this group, 21 patients survived until January 1, 1985, and four of them had biopsy-proven Ca which caused ureteral obstruction. In both early and advanced stages, 13 patients with post-treatment ureteral obstruction were lost to follow-up, but the remaining 287 cases have been followed until death or at least 4 years after detection of the ureteral obstruction. The median follow-up was 64.2 months, and seven patients have survived beyond 10 years. This review shows that 12% of the patients with early stage and 18% with advanced stage carcinoma of the uterine cervix seen in this institution developed some degree of detectable ureteral obstruction. Biopsy-proven evidence of recurrent or persistent carcinoma indicating the Ca to cause posttreatment ureteral obstruction in early stages of cervical carcinoma was 40% and in advanced stages was 66%.(ABSTRACT TRUNCATED AT 400 WORDS)

Combined Modality Therapy↗
PubMed1980

Laparoscopy as a diagnostic aid in women with localized ureteral obstruction due to endometriosis.

Endometriosis is a common disease which can produce localized ureteral obstruction. Many women will have significant disease without any clinical signs or symptoms until they present with distal ureteral obstruction. In the reported literature, the diagnosis of ureteral involvement by endometriosis usually has been made at surgery. It is therefore suggested that women with distal ureteral obstruction not attributable to calculous disease undergo laparoscopy in an attempt to rule out endometriosis as the cause of ureteral obstruction.

Adult↗
PubMed2001

Covered metallic ureteral stent in the management of malignant ureteral obstruction: preliminary results.

OBJECTIVES: To evaluate the effectiveness of ureteral Dacron-covered metallic stents in the management of malignant ureteral obstruction. METHODS: Covered metallic stents were placed unilaterally using a percutaneous approach in an antegrade fashion into nine ureters of 8 patients with bilateral malignant ureteral obstruction. The contralateral kidneys were drained by percutaneous nephrostomy in 7 patients. The primary diagnoses were rectal cancer in 5 patients and cervical, bladder, and prostate cancers in the remaining cases. RESULTS: Covered metallic stents could be successfully placed in all patients. Only one of nine ureters was stented with a double J-stent. In a mean follow-up of 9 months (range 1 to 14), 7 of 8 patients died because of their primary disease. During the follow-up period, none of the stents were obstructed, displaced, or infected. CONCLUSIONS: Dacron-covered metallic stents appear to be successful in the treatment of patients with malignant ureteral obstruction. The preliminary outcome encourages and justifies the application of this drainage method.

Adult↗